11 Jun Oncotype DX Breast Cancer Assay Quickly Adopted Under Medicare Guidelines
Medical Research: What is the background for this study? What are the main findings?
Response: I think it will be critical to further explore the implications of Oncotype DX breast cancer assay (ODX testing) in women with breast cancer. The ODX test helps predict which cancers will be more aggressive as well as guide recommendations as to which patients would most likely benefit from chemotherapy. I think we should look to see what impact this test is really having on the use of chemotherapy and its associated costs and outcomes for real-world breast cancer patients.
Medical Research: What should clinicians and patients take away from your report?
Response: Another interesting finding of this study was the lack of variation in ODX use by race, geography, or, socioeconomic status. Often for emerging medical technologies, we tend to see differences in initial use for these patient populations. Our analysis did not examine why we didn’t see this differential utilization with the emergence of Oncotype DX breast cancer assay, but clinicians and patients should be aware that the test is available to them without obvious barriers to its use in cases where it is medically indicated.
Medical Research: What recommendations do you have for future research as a result of this study?
Response: We wanted to examine how ODX was being used in real-world practice at the population level. ODX has been examined in clinical trials and limited academic settings but we know that these patients are often younger, have fewer medical comorbidities, and do not necessarily accurately reflect the majority patients with cancer. In our study, we observed that ODX was being used predominately in accordance with guidelines which recommend the test for women with estrogen-receptor positive, node negative disease. We also looked just at women under the age of 70 who met guideline criteria for testing, because this population would include those women who were more likely to be chemotherapy candidates, and we saw a rapid uptake of the test between 2005 and 2009, with use of the test increasing from 8% to 39%.
Dinan MA, Mi X, Reed SD, Hirsch BR, Lyman GH, Curtis LH. Initial Trends in the Use of the 21-Gene Recurrence Score Assay for Patients With Breast Cancer in the Medicare Population, 2005-2009. JAMA Oncol. 2015;1(2):158-166. doi:10.1001/jamaoncol.2015.43.
Michaela Dinan, Ph.D. Duke Clinical Research Institute and Duke Cancer Institute, Department of Medicine, Duke University School of Medicine, Durham, North Carolina (2015). Oncotype DX Breast Cancer Assay Quickly Adopted Under Medicare Guidelines